Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Summary
Humana Medicaid Indiana has revised the prior authorization policy for Erwinase (asparaginase Erwinia chrysanthemi), a chemotherapy agent used to treat acute lymphoblastic leukemia (ALL) in patients who developed hypersensitivity to prior asparaginase therapy. The policy requires prior authorization with specific clinical criteria (Grade 2-4 hypersensitivity to Oncaspar documented, use in multi-agent chemotherapy) and excludes patients with serious history of pancreatitis, thrombosis, hemorrhage, or disease progression on asparaginase therapy. Approval is granted for initial and renewal periods of 6 months or as determined through clinical review.
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